Hemorragia obstétrica y rotura uterina por un embarazo intersticial. Reporte de un caso / Obstetric hemorrhage and uterine rupture due to an interstitial pregnancy. Report of a case

RESUMEN

Resumen ANTECEDENTES El embarazo ectópico intersticial ocurre en 2.4% de los casos, quizá debido a la rotura uterina, con lo que se incrementa la morbilidad y mortalidad por hemorragia obstétrica. Los factores de riesgo son los mismos que para el embarazo ectópico tubárico. El tratamiento se establece en función del escenario clínico y deseo genésico de la paciente. CASO CLÍNICO Paciente de 31 años, que ingresó al servicio de Urgencias por dolor abdominal severo e incapacitante en el hipogastrio, con índice de choque de 1.3 y signos de irritación peritoneal. La ecografía reportó líquido libre en el hueco pélvico y el espacio de Morrison; el saco gestacional extrauterino se encontraba en el anexo izquierdo, el feto sin latido cardiaco, con longitud craneocaudal de 11 semanas de gestación. La laparotomía exploradora evidenció hemoperitoneo de 2800 cc, rotura uterina en el cuerno derecho, de aproximadamente 8 x 6 cm, visualización del feto e integridad de la bolsa amniótica. Puesto que la paciente manifestó no desear más embarazos se decidió efectuar la histerectomía total abdominal. CONCLUSIONES: El embarazo ectópico intersticial comparte los mismos factores de riesgo que el embarazo tubárico. Hoy día se dispone de diversos métodos de diagnóstico; sin embargo, la detección oportuna permite implementar el tratamiento conservador a seguir y, así, disminuir la morbilidad y mortalidad materna.

ABSTRACT

Abstract BACKGROUND: Interstitial ectopic pregnancy occurs in approximately 2.4% of all cases, this tubal portion is located in the proximal segment and shares the muscular portion of the uterus, due to its great myometrial compliance, it facilitates late diagnosis and its clinical presentation is By means of uterine rupture and with it an increase in morbidity and mortality due to obstetric hemorrhage, the risk factors are the same as for tubal ectopic pregnancy, treatment is assessed based on preserving fertility and according to the patient's clinical setting. CLINICAL CASE A 31-year-old patient who went to the emergency department for severe and disabling abdominal pain in the hypogastrium, shock index 1.3, with signs of peritoneal irritation, ultrasound was performed, which reported free fluid in the pelvic cavity and Morrison space, extrauterine gestational sac at the level of the left annex, embryo without heartbeat, craniocaudal length of 11 weeks of gestation, exploratory laparotomy was performed, in which hemoperitoneum of 2800 cc was observed, uterine rupture in the right cornual region of approximately 8x6cm, with fetus e integrity of the amniotic sac adjacent to the uterine rupture, the patient reported satisfied parity, and therefore a total abdominal hysterectomy was decided. CONCLUSIONS: Interstitial ectopic pregnancy shares the same risk factors as tubal pregnancy. Today, we have various diagnostic aids, so the cornerstone is timely detection, which will allow conservative treatments to decrease maternal morbidity and mortality.